Functional disorders

What are the symptoms of functional disorders?

General symptoms
Fatigue, difficulty concentrating, headaches, memory problems, dizziness

Gastrointestinal symptoms
Diarrhea, constipation, stomach pain, bloating, acid reflux, heartburn.

Cardiovascular symptoms
​Heart palpitations, chest tightness, shortness of breath without exertion, “butterflies” in the stomach, hot and/or cold sweats, dry mouth

Muscular symptoms
​Pain in arms, legs, back and joints in general. Pain that moves around the body, feeling of paralysis and loss of strength and sensory disturbances.

The symptoms of functional disorders often move around, and typically vary in character, intensity, and location. You will often have a sensitive system, which means that light, sound, and light stress can feel like overload.

Functional level is often impaired to such an extent that it is difficult to function in daily life or perform a job.

Exclusion criteria

• Symptoms must not be better explained by physical or mental illness.
• Patients must not have severe psychopathology such as psychosis, etc.
• The primary issue must not be health anxiety

What are functional disorders?

​Functional disorder has become a recognized diagnosis, as it is recognized that people with this disorder have physical symptoms. These physical symptoms are of such a nature that they are affected in daily activities and work life.

What the many physical symptoms have in common is that they are not attributed to an actual physical/mental illness such as high blood pressure, Crohn’s disease or inflammation of a tendon, hernia, etc.

However, the symptoms have become a disease, and is a disorder where the brain and body have difficulty cooperating, and thus quickly become overloaded.

​So we are talking about the body and brain not being in balance and not working well enough together. The symptoms are many, as described above, and some people may have many symptoms, while others may have few. However, what is common to the group is that they are disabled to such an extent that their quality of life has deteriorated.​

How are functional disorders diagnosed?

​People with this disorder have often gone through a lengthy evaluation process at the hospital or at a center for functional disorders. They are often told that nothing is found on scans, blood tests, etc.

In addition, you must have had symptoms for more than 3 months to be able to make the diagnosis – in some places up to 6 months.

What are the causes of functional disorders?

The theory behind the cause is still unknown. However, there are various hypotheses. One of them is the interaction between the nervous system and the body.

However, there is broad agreement in research circles that there are multifactorial causes for the problem.

Our nervous system

We have the autonomic nervous system, which consists of the sympathetic and parasympathetic nervous systems.

Sympathetic is our fight & flight system, which enables the body to fight in difficult situations. For example, it can be before an exam, if you have been through a trauma, stress at work and much more. In the case that sympathetic is activated, several physiological reactions occur in our body.

​The body’s own stress response is activated. The HPA axis will become more active, which is a hormonal axis in the body that causes our adrenaline, noradrenaline and cortisol levels to increase. These are our stress hormones that allow us to perform better in stressful situations.

The importance of hormones

​If our stress hormones increase, we will generally suppress the body’s own ability to heal and regenerate cells. This can result in various inflammation problems in the body, which can be difficult to get rid of. You can also end up with fluctuating symptoms around the body that cannot be linked to anatomy etc.

Furthermore, our gastrointestinal system will be challenged as the body will deprioritize digestion. It is not important to be able to digest your food if the brain thinks it is being eaten by a lion.

Therefore, many people who have a stressed nervous system may experience digestive problems. These can include diarrhea, constipation, cramps and bloating. In addition, people may also experience a decrease in tolerance to various foods, as they often require more energy to break down (G. Ortego et al, 2016).

If our system has been too active, for too long, we can end up being burned out, to which the body’s upper limit for stimuli is reduced.

In addition, our nervous system will become more sensitive, which means that we will now experience all/many stimuli as being more sensitive, and in some cases as pain. This can be touch, digestive problems, exercise and daily tasks, which can worsen one’s problems.

The brain cannot tell the difference between physical, mental or chemical stress, and therefore the body will react in the same way in different situations.

You can therefore experience the same symptoms from too little sleep, high bills, too much exercise, or something completely different.

What are the triggers for functional disorders?

Many with functional disorders have experienced a major defining experience that has been the driving force behind the new symptoms. It can be, for example, a traffic accident, stress at work or a short/long period of illness. Symptoms can come on acutely and remain there. But there is a large group who experience insidious and increasing symptoms that worsen over time.

Is it difficult to break the vicious spiral?

​Daily behavior has a crucial impact on how your symptoms may manifest. This can include eating habits, your own beliefs about whether something in your body is broken or can easily break. This is even if your body is robust and strong.

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It can also be in another ditch, where you think that training is the way forward, which easily leads to overtraining, and then lying fallow for several days/weeks.

It should also be mentioned that training can be social activities as well as real strength training in the gym.

Other external factors are; finances, social status, marriage and basically how well one’s life is connected to external factors.

You therefore play a large role in shaping your own symptoms, which requires knowledge and education about your own body to stop the downward spiral (P. Rasmussen, 1996).

​You can also have an imbalance in the autonomic nervous system, which is a nervous system that deals with the function of organs, seen from the body’s threat level. If you have problems with organs, due to illness, poor breakdown of food or other things, this will create increased stimuli to, for example, the neck or back, which can increase your pain problems.

​It should be mentioned here that there may be situations where you are in a dilemma. For example, medication can help with some symptoms, but cause others. Here it is always a matter of assessment, in consultation with your doctor, about which symptoms you can best live with. It is therefore not always so black and white in relation to why your symptoms are maintained.

There is always a multifactorial cause for the maintenance of chronic and severe symptoms, and a broad and holistic approach to the problem is therefore needed.

Good advice for functional disorders

It is important to mention that the symptoms experienced by the individual are real. Therefore, the healthcare professional should acknowledge the person’s problem and not sweep it under the carpet with phrases such as: “It’s probably psychological”, or “pull yourself together”, “There’s nothing wrong with you”.

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If your symptoms are not recognized, the healthcare system will often have difficulty helping you further, and you will end up stuck in the system.

It’s also about being able to accept your situation and look forward.

​After this, it may be necessary to map out which symptoms you have and what triggers there may be. If you map out symptoms and potential causes, you can start working with them, so that you can eventually shift your tolerance for the individual problem.

​However, it is important to keep in mind that the body’s hierarchical healing is important. If you are in a prolonged stressful period where everything is difficult, it may be necessary to handle that thing before addressing other important factors (A. Crum, P. Salovey and S. Anchor, 2013).

​​When faced with stress in everyday life, whether at work, at home or somewhere else, it can be a good idea to have clear boundaries for yourself and your surroundings. This way, you won’t be pushed out of your comfort zone without being in control of it.

Set aside time in your calendar for your tasks. This way you will spend less energy and effort thinking and speculating about what you will and will not achieve.

Meditation can be a great tool to feel yourself again, and start breathing more calmly and deeply. It can be anything from several times a day, for a few minutes, to once a day, which can be short or long.

Physical training and functional disorders

​It is important to gradually train the individual problem, so that you do not get a roller coaster effect but many ups and downs. You should gradually experience progress (maybe small progress) and experience success through what you do. It is important here that you find an activity that interests you and that you want to get done. (A. Deslandes et al, 2009).

This will increase the motivation to keep training, so that you can reverse the downward spiral.

Prevention of functional disorders

Functional disorders can be small, transient episodes, but can also be long-term and chronic. It is important to remember that functional disorders may have arisen due to an accident or injury. This can be difficult to prevent.

​Going beyond this, and looking generally, we know that the body wants to be in balance. This means that if the body does not experience severe long-term stress leading up to the accident, there will be less risk of developing functional disorders.

​Diet, smoking, alcohol, exercise, medication, sleep and stress are important to work on, as they are our basis for good health in the body. If you eat a healthy and varied diet, get some exercise that makes you happy, keep alcohol and smoking to a minimum, and get enough sleep, you will have a good chance of reversing the bad spiral and not worsening the condition.

Functional disorders of children and adolescents

It is estimated that between 4-10% of children and adolescents are affected by functional disorders. In young children, there is no difference between boys and girls, but there is an increasing tendency towards a preponderance of girls as the children get older.

The most frequent symptoms are:

• ​Headache
• Stomach pain
• Chronic fatigue
• Muscle/joint pain

Just like with adults, functional disorders can be caused by several different things. For example, childhood trauma, illness, the immune system, and social reasons related to the life one lives.

​During the assessment, you will experience a thorough review of the child’s history, where parental involvement is important. Especially for children under 9-10 years of age, as they may have difficulty expressing themselves. This will often also include kindergarten/school arrangements, family circumstances and an objective examination of height and weight, etc.

The treatment of children will be largely focused on supporting the child where they are, as well as helping the child’s network with resources so that everything around the child functions as optimally as possible.

​In addition, manual therapy can help calm the nervous system, relieve pain, and improve the body’s self-healing mechanisms. Dietary guidance and exercise may also be relevant to consider.

What can osteopathy do?

Osteopathy is a holistic form of treatment that attempts to map your symptoms and causes. To do this, link them together.

Osteopathy works on 5 main topics:

• ​Biomechanical (Muscles, joints, etc.)
• Nervous system.
• The endocrine system (Hormones)
• Respiratory and circulatory system (Breathing and blood, etc.)
• The biopsychosocial system, which can be stress, external factors, behavior around one’s own problems.

There will therefore be an initial conversation where you review and talk about the different topics, and see if there can be more clues to work with, to get closer to a balance between body and nervous system. It is not possible to only look at biomechanics if you also have gastrointestinal problems, or are very stressed.

The body will at all times prioritize the most important parts, for example the brain over digestion, digestion over biomechanics, as there are systems in the body that, hierarchically, are more important for our survival.

​The treatment will therefore be tailored to the individual, as there may be different systems to work with for each individual. There may be gradual rehabilitation, diet and lifestyle changes. Manual treatment of the different areas as well as knowledge and skills to understand your own body, so that you can better take care of it yourself.

The more knowledge you have about your own body, symptoms and pain, the better able you will be to challenge, adapt and manage your everyday life so that you get the most out of it, with the least possible pain.

​Here at Aarhus Osteopathy, we are experts in seeing and understanding the whole person, and treating holistically, from the perspective of the body’s hierarchies and the different systems. You will therefore experience help on more parameters than just pain.